Acute subdural hematoma evacuation: Predictive factors of outcome

Abstract

Background: Acute subdural hematoma (aSDH) is a major cause of admission at Neurosurgical Emergency Department. Nevertheless, concerns regarding surgical indication in patients with multiple comorbidities, poor neurological status, antithrombotic therapy, and older age still persist. Therefore, a correct recognition of predictive outcome factors at hospital discharge is crucial to an appropriate neurosurgical treatment. Methods: Eighty-nine medical records of consecutive patients with age ≥18 years old who were submitted to aSDH evacuation between January 2008 and May 2012 were reviewed. Demographic characteristics, neurological status on admission, anticoagulant or antiplatelet therapy, and outcome on discharge were collected. Patients with insufficient data concerning these variables were excluded from the study. Results: Sixty-nine patients were included; 52% were male; 74% were older than 65 years; 41% were under oral antithrombotic therapy (OAT); at admission, 54% presented with Glasgow coma scale (GCS) ≤8; 23% were submitted to a craniectomy instead of a craniotomy; 26% of the patients died, 32% were dependent, and 42% were independent on discharge. Crude analysis revealed craniectomy, A/A pupils, GCS ≤8 at admission statistically significant related with the worst outcome (P < 0.05). In the adjusted evaluation only A/A pupils (P = 0.04) was associated to poor outcome (spontaneous etiology P = 0.052). Considering daily living independency at hospital discharge, either male gender (P = 0.044) and A/A pupils (P = 0.030) were related to the worst outcome. No effect of age in outcome was observed. Conclusions: Male gender and A/A pupils are associated with lower probability of achieving independency living at hospital discharge. A/A pupils, low GCS at admission, spontaneous etiology, and craniectomy were associated with the worst outcome. Age and OAT were not predictive factors in this series. Caution should be taken when considering these factors in the surgical decision.

Gender Discrepancy in Patients with Traumatic Brain Injury: A Retrospective Study from a Level 1 Trauma Center

“…The small number of females might be misrepresentative of this gender; however, this limitation has been observed in the majority of prior studies. The outcome after TBI might be influenced by patient's comorbidity such as diabetes mellitus, hypertension, dyslipidemia, smoking, chronic obstructive pulmonary disease, and heart disease; however, our data could be unique in terms of patient age in comparison to prior studies from other countries [ 14 – 18 ] as the mean age in our cohort is 34 ± 14 which precludes the presence of high proportion of comorbidities. However, diabetes mellitus and hypertension were found in 11.8%, and multivariate analysis showed that they did not have a significant predictor role for mortality.…”

“…This higher rate of acute traumatic SDH among males than females was also reported in many previous studies from different countries. For instance, the proportions of affected males were 52% (Portugal), 53% (Italy and Spain), 64% (Japan), 65% (the USA), and 74% (Brazil) [ 14 – 18 ]. However, there is no reported explanation in the literature for such gender discrepancy.…”

“…However, there is no reported explanation in the literature for such gender discrepancy. In traumatic SDH, gender was not influencing the hospital survival [ 15 – 18 ]; however, male gender was associated with a poor functional outcome in one study [ 14 ]. Although in-hospital mortality was comparable by gender, males ≥55 years had a higher mortality rate when compared to young age males in our study.…”

A multicentre retrospective cohort study on health-related quality of life after traumatic acute subdural haematoma: does cranial laterality affect long-term recovery?

“…It is estimated that approximately 5.3 million people in the USA and approximately 7.7 million people in the European Union are living with disabilities related to TBI [3,4]. Acute subdural haematoma (ASDH) is one of the most harmful forms of TBI [5][6][7]. The haemorrhage is located in the subdural space and is often associated with a contusion or an intracerebral haematoma [3,6].…”

“…Acute subdural haematoma (ASDH) is one of the most harmful forms of TBI [5][6][7]. The haemorrhage is located in the subdural space and is often associated with a contusion or an intracerebral haematoma [3,6]. A traumatic ASDH can be treated either surgically or conservatively.…”